Skip to main content Accessibility help

Sharps-Related Injuries in California Healthcare Facilities: Pilot Study Results From the Sharps Injury Surveillance Registry

  • Marion Gillen (a1), Jennifer McNary (a1), Julieann Lewis (a1), Martha Davis (a1), Alisa Boyd (a1), Mary Schuller (a1), Chris Curran (a1), Carol A. Young (a1) and James Cone (a2)...


Background and Objectives:

In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California.


Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network.


These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.


Corresponding author

UCSF School of Nursing, Department of Community Health Systems, Box 0608, San Francisco, CA 94143-0608


Hide All
1. California Senate Bill No. 2005, Chapter 683. (September 23, 1996).
2. California Assembly Bill No. 1208, Chapter 999. (September 30, 1998).
3.Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries: final rule. Federal Register 2001;66:53185325.
4. Pub L No. 106430, Needlestick Safety and Prevention Act. (November 6, 2000).
5.National Institute for Occupational Safety and Health. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. Washington, DC: National Institute for Occupational Safety and Health; 1999. DHHS (NIOSH) publication no. 2000-108.
6.Burke, S, Madan, I. Contamination incidents among doctors and mid-wives: reasons for non-reporting and knowledge of risks. Occup Med (London) 1997;47:357360.
7.Hamory, BH. Under reporting of needlestick injuries in a university hospital. Am J Infect Control 1983;11:174177.
8.Mercier, C. Reducing the incidence of sharps injuries. Br J Nurs 1994;3:897-898, 900901.
9.Occupational Safety and Health Administration, Directorate of Technical Support, Office of Occupational Health Nursing. Safer Needle Devices: Protecting Health Care Workers. Washington, DC: Occupational Safety and Health Administration; 1997.
10.Centers for Disease Control. Recommendations for preventing transmission of HIV and HBV to patients during exposure-prone invasive procedures. MMWR 1991;40(RR-8):19.
11.Centers for Disease Control and Prevention. Immunization of health care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(RR-18):142.
12.Centers for Disease Control and Prevention. Recommendations for follow-up of health care workers after occupational exposure to hepatitis C virus. MMWR 1997;46:603606.
13.Centers for Disease Control and Prevention. Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures: New York City, March 1993-June 1994. MMWR 1997;46:2529.
14.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures: Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR 1997;46:2125.
15.Centers for Disease Control and Prevention. Public health service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR 1998;47(RR-7):128.
16.Gerberding, JL. Management of occupational exposures to blood-borne viruses. NEngl J Med 1995;332:444451.
17.Hanrahan, A, Reutter, L. A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention. J Adv Nurs 1997;25:144154.
18.Aiken, LH, Sloane, DM, Klocinski, JL. Hospital nurses' occupational exposure to blood: prospective, retrospective, and institutional reports. Am J Public Health 1997;87:103107.
19.Folin, AC, Nordstrom, OM. Accidental blood contact during orthopedic surgical procedures. Infect Control Hosp Epidemiol 1997;18:244246.
20.Fraser, VJ, Powderly, WG. Risks of HIV infection in the health care setting. Annu Rev Med 1995;46:203211.
21.Gershon, RRM, Karkashian, CD, Vlahov, D, et al. Compliance with universal precautions in correctional health care facilities. J Occup Environ Med 1999;41:181189.
22.Haiduven, D, Askari, E, Gross, R, Fisher, J. Bloodborne exposures in the home care setting: a multi-center analysis. Am J Infect Control 1997;25:134. Abstract.
23.Lum, D, Mason, Z, Meyer-Rochow, G, et al. Needle stick injuries in country general practice. N Z Med J 1997;110:122125.
24.Lymer, UB, Schutz, AA, Isaksson, B. A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden. J Hosp Infect 1997;35:223235.
25.White, MC, Lynch, P. Blood contact and exposures among operating room personnel: a multicenter study. Am J Infect Control 1993;21:243248.
26.Asai, T, Matsumoto, S, Matsumoto, H, Yamamoto, K, Shingu, K. Prevention of needle-stick injury: efficacy of a safeguarded intravenous cannula. Anaesthesia 1999;54:258261.
27.Bhardwaj, D, Norris, A, Wong, DT. Is skin puncture beneficial prior to arterial catheter insertion? Can J Anaesth 1999;46:129132.
28.Brown, JD, Moss, HA, Elliott, TSJ. The potential for catheter microbial contamination from a needleless catheter. J Hosp Infect 1997;36:181189.
29.Chiarello, LA. Selection of needlestick prevention devices: a conceptual framework for approaching product evaluation. Am J Infect Control 1995;23:386395.
30.Ihrig, M, Cookson, ST, Campbell, K, Harstein, AI, Jarvis, WR. Evaluation of the acceptability of a needleless vascular-access system by nurses. Am J Infect Control 1997;25:434438.
31.Jagger, J, Bentley, MB, the Collaborative EPINet Surveillance Group. Injuries from vascular access devices: high risk and preventable. J Intraven Nurs 1997;20(suppl):S33S39.
32.Kempen, PM. Assessing blunt cannulae as replacements for hypodermic needles during intravenous therapy: safety and utility. Infect Control Hosp Epidemiol 1997;18:169174.
33.Lawrence, LW, Delclos, GL, Felknor, SA, et al. The effectiveness of a needleless intravenous connection system: an assessment by injury rate and user satisfaction. Infect Control Hosp Epidemiol 1997;18:175182.
34.L'Ecuyer, PB, Schwab, EO, Iademarco, E, Barr, N, Aton, EA, Fraser, VJ. Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates. Infect Control Hosp Epidemiol 1996;17:803808.
35.Loudon, MA, Stonebridge, PA. Minimizing the risk of penetrating injury to surgical staff in the operating theatre: towards sharp-free surgery. J R Coll Surg Edinb 1998;43:68.
36.Mendelson, MH, Short, LI, Schechter, CB, et al. Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes. Infect Control Hosp Epidemiol 1997;19:401406.
37.Quiroga, R, Halkyer, P, Gil, F, Nelson, C, Kristensen, D. A prefilled injection device for outreach tetanus immunization by Bolivian traditional birth attendants. Pan American Journal of Public Health 1998;4:2025.
38.Yassi, A, McGill, ML, Khokhar, JB. Efficacy and cost-effectiveness of a needleless intravenous access system. Am J Infect Control 1995;23:5764.
39.Younger, B, Hunt, EH, Robinson, C, McLemore, C. Impact of a shielded safety syringe on needlestick injuries among healthcare workers. Infect Control Hosp Epidemiol 1992;13:349353.
40.Zafar, AB, Butler, C, Podgorny, JM, Mennonna, PA, Gaydos, LA, Sandiford, JA. Effect of a comprehensive program to reduce needlestick injuries. Infect Control Hosp Epidemiol 1997;18:712715.
41.Arduino, MJ, Bland, IA, Danzig, LE, McAllister, SK, Aguero, SM. Microbiologic evaluation of needleless and needle-access devices. Am J Infect Control 1997;26:377380.
42.Chodoff, A, Pettis, A, Schoonmaker, D, Shelly, M. Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous system. Am J Infect Control 1995;23:357363.
43.Danzig, LE, Short, LJ, Collins, K, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995;273:18621864.
44.McDonald, IX, Banerjee, S, Jarvis, W. Central venous catheter (CVQ-associated bloodstream infections (BSI) in intensive care unit patients associated with needleless access devices. Infect Control Hosp Epidemiol 1997;18:24.
45.Russo, PL, Harrington, GA, Spelman, DW. Needleless intravenous systems: a review. Am J Infect Control 1999;27:431434.
46.Emergency Care Research Institute (ECRI). Health devices: special report and product review. Health Devices 1991;20:154180.
47.Becker, CE, Gerberding, J, Cone, J. HIV risk and risk reduction. Ann Intern Med 1989;110:653656.
48.Centers for Disease Control and Prevention, The National Surveillance System for Health Care Workers (NaSH). Summary Report for Data Collected From June 1995 Through July 1999, Division of Healthcare Quality Promotion. Atlanta, GA: Centers for Disease Control and Prevention; 2001. Available at
49.Exposure Prevention Information Network (EPINet). Exposure Prevention Information Network Data Reports. Charlottesville, VA: International Health Care Worker Safety Center, University of Virginia; 1999. Available at
50.California Office of Statewide Health Planning and Development (OSHPD). Hospital Annual Financial Data Profile, 1999. Available at www.oshpd.cahwnetgov/defaulthtm. 2001.
51.Baker, EL, Matte, TP. Surveillance of occupational illness and injury. In: Halperin, W, Baker, EL, Monson, RR, eds. Public Health Surveillance. New York: Van Nostrand Reinhold; 1992:178194.
52.Puro, V, Ippolito, G. Safety butterfly needles for blood drawing. Infect Control Hosp Epidemiol 1998;19:299.
53.Exposure Prevention Information Network (EPINet). Data Reports: 1993 through 1995, 77 Hospitals. Charlottesville, VA: International Health Care Worker Safety Center, University of Virginia; 1997. Available at
54.Froom, P, Kristal-Boneh, E, Melamed, S, Shalom, A, Ribak, J. Prevention of needle-stick injury by the scooping-resheathing method. Am J Ind Med 1998;34:1519.
55.Gillen, M, Davis, M, McNary, J, et al. Sharps injury recordkeeping activities and safety product use in California healthcare facilities: pilot study results from the Sharps Injury Control Program. Am J Infect Control 2002;30:269276.
56.Exposure Prevention Information Network (EPINet). Data Reports (2000). Charlottesville, VA: International Health Care Workers Safety Center, University of Virginia. Available at 2001.
57.Centers for Disease Control and Prevention, National Surveillance System for Health Care Workers (NaSH). Spotlights—March 2000: Needlestick Injuries Involving Winged Steel Needles. Atlanta, GA: Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion; 2001. Available at
58.Patel, N, Tignor, GH. Device-specific sharps injury and usage rates: an analysis by hospital department. Am J Infect Control 1997;25:7784.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed